| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
47,976 |
46,993 |
$1.61M |
| D1206 |
Topical application of fluoride varnish |
50,427 |
49,244 |
$1.18M |
| D1351 |
Sealant - per tooth |
65,101 |
13,710 |
$1.15M |
| D0120 |
Periodic oral evaluation - established patient |
49,553 |
48,554 |
$960K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,741 |
9,663 |
$726K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,067 |
7,167 |
$437K |
| D8670 |
Periodic orthodontic treatment visit |
9,881 |
9,711 |
$435K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,494 |
2,346 |
$370K |
| D0272 |
Bitewings - two radiographic images |
26,984 |
26,540 |
$204K |
| D1110 |
Prophylaxis - adult |
5,456 |
5,255 |
$201K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,102 |
12,830 |
$165K |
| D0603 |
|
27,558 |
26,636 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,080 |
1,898 |
$131K |
| D8660 |
|
4,449 |
4,381 |
$118K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
194 |
193 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
2,427 |
2,356 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,115 |
4,008 |
$70K |
| D8680 |
|
64 |
64 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
13,070 |
12,660 |
$53K |
| D0601 |
|
7,552 |
7,431 |
$53K |
| D0274 |
Bitewings - four radiographic images |
5,962 |
5,734 |
$45K |
| D0602 |
|
5,817 |
5,742 |
$38K |
| D0330 |
Panoramic radiographic image |
1,383 |
1,379 |
$29K |
| D1354 |
|
4,451 |
1,005 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,187 |
1,187 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
416 |
314 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,947 |
6,972 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
178 |
100 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
532 |
515 |
$7K |
| D2390 |
|
51 |
25 |
$4K |
| D7111 |
|
99 |
68 |
$3K |
| D0340 |
|
210 |
207 |
$3K |
| D2330 |
|
38 |
26 |
$2K |
| D0470 |
|
459 |
449 |
$2K |
| D2332 |
|
22 |
18 |
$1K |
| D0270 |
|
244 |
242 |
$1K |
| D9430 |
|
36 |
36 |
$870.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$540.00 |
| D9920 |
|
27 |
25 |
$414.00 |
| D0350 |
|
328 |
322 |
$309.00 |
| D0273 |
|
20 |
20 |
$189.24 |
| D9910 |
|
33 |
30 |
$70.00 |
| D1330 |
|
24,682 |
23,505 |
$0.00 |
| D1310 |
|
23,225 |
22,087 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
12 |
$0.00 |
| D1999 |
|
16,573 |
14,849 |
$0.00 |